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CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression.
Clin Infect Dis 2007; 44(3):441-6CI

Abstract

BACKGROUND

Sustained suppression of the human immunodeficiency virus (HIV) type 1 RNA load with the use of highly active antiretroviral therapy (HAART) results in immunologic improvement, but it is not clear whether the CD4(+) cell count increases to normal levels or whether it reaches a less-than-normal plateau. We characterized the increase in the CD4(+) cell count in patients in clinical practice who maintained sustained viral suppression for up to 6 years.

METHODS

All patients were from the Johns Hopkins HIV Clinical Cohort, a longitudinal observational study of patients receiving primary HIV care in Baltimore, Maryland, who were observed for >1 year while receiving HAART and who had sustained suppression of the HIV RNA load at <400 copies/mL. We analyzed annual change in the CD4(+) cell count for up to 6 years after the start of HAART, stratified by baseline CD4(+) cell counts of < or =200, 201-350, >350 cells/microL, and we assessed the development of clinical events (death and new acquired immunodeficiency syndrome-defining illness) by Kaplan-Meier analysis.

RESULTS

A total of 655 patients were observed for a median of 46 months (range, 13-72 months). The median change from baseline to most recent CD4(+) cell count was +274 cells/microL, with 92% of patients having an increase in CD4(+) cell count. By 6 years, the median CD4(+) cell count was 493 cells/microL among patients with baseline CD4(+) cell counts < or =200 cells/microL, 508 cells/microL among those with baseline CD4(+) cell counts of 201-350 cells/microL, and 829 cells/microL among those with baseline CD4(+) cell counts >350 cells/microL. In addition to baseline CD4(+) cell count, injection drug use and older age were associated with a lesser CD4(+) cell count response, and duration of therapy was associated with a greater CD4(+) cell count response.

CONCLUSION

Only patients with baseline CD4(+) cell counts >350 cells/microL returned to nearly normal CD4(+) cell counts after 6 years of follow-up. Significant increases were observed in all CD4(+) cell count strata during the first year, but there was a lower plateau CD4(+) cell count at lower baseline CD4(+) cell strata. These data suggest that waiting to start HAART at lower CD4(+) cell counts will result in the CD4(+) cell count not returning to normal levels.

Authors+Show Affiliations

Johns Hopkins University School of Medicine, Baltimore, MD, USA. rdmoore@jhmi.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17205456

Citation

Moore, Richard D., and Jeanne C. Keruly. "CD4+ Cell Count 6 Years After Commencement of Highly Active Antiretroviral Therapy in Persons With Sustained Virologic Suppression." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 44, no. 3, 2007, pp. 441-6.
Moore RD, Keruly JC. CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clin Infect Dis. 2007;44(3):441-6.
Moore, R. D., & Keruly, J. C. (2007). CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 44(3), pp. 441-6.
Moore RD, Keruly JC. CD4+ Cell Count 6 Years After Commencement of Highly Active Antiretroviral Therapy in Persons With Sustained Virologic Suppression. Clin Infect Dis. 2007 Feb 1;44(3):441-6. PubMed PMID: 17205456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. AU - Moore,Richard D, AU - Keruly,Jeanne C, Y1 - 2006/12/20/ PY - 2006/08/11/received PY - 2006/09/28/accepted PY - 2007/1/6/pubmed PY - 2007/1/26/medline PY - 2007/1/6/entrez SP - 441 EP - 6 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 44 IS - 3 N2 - BACKGROUND: Sustained suppression of the human immunodeficiency virus (HIV) type 1 RNA load with the use of highly active antiretroviral therapy (HAART) results in immunologic improvement, but it is not clear whether the CD4(+) cell count increases to normal levels or whether it reaches a less-than-normal plateau. We characterized the increase in the CD4(+) cell count in patients in clinical practice who maintained sustained viral suppression for up to 6 years. METHODS: All patients were from the Johns Hopkins HIV Clinical Cohort, a longitudinal observational study of patients receiving primary HIV care in Baltimore, Maryland, who were observed for >1 year while receiving HAART and who had sustained suppression of the HIV RNA load at <400 copies/mL. We analyzed annual change in the CD4(+) cell count for up to 6 years after the start of HAART, stratified by baseline CD4(+) cell counts of < or =200, 201-350, >350 cells/microL, and we assessed the development of clinical events (death and new acquired immunodeficiency syndrome-defining illness) by Kaplan-Meier analysis. RESULTS: A total of 655 patients were observed for a median of 46 months (range, 13-72 months). The median change from baseline to most recent CD4(+) cell count was +274 cells/microL, with 92% of patients having an increase in CD4(+) cell count. By 6 years, the median CD4(+) cell count was 493 cells/microL among patients with baseline CD4(+) cell counts < or =200 cells/microL, 508 cells/microL among those with baseline CD4(+) cell counts of 201-350 cells/microL, and 829 cells/microL among those with baseline CD4(+) cell counts >350 cells/microL. In addition to baseline CD4(+) cell count, injection drug use and older age were associated with a lesser CD4(+) cell count response, and duration of therapy was associated with a greater CD4(+) cell count response. CONCLUSION: Only patients with baseline CD4(+) cell counts >350 cells/microL returned to nearly normal CD4(+) cell counts after 6 years of follow-up. Significant increases were observed in all CD4(+) cell count strata during the first year, but there was a lower plateau CD4(+) cell count at lower baseline CD4(+) cell strata. These data suggest that waiting to start HAART at lower CD4(+) cell counts will result in the CD4(+) cell count not returning to normal levels. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17205456/CD4+_cell_count_6_years_after_commencement_of_highly_active_antiretroviral_therapy_in_persons_with_sustained_virologic_suppression_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/510746 DB - PRIME DP - Unbound Medicine ER -